U.S. NAVAL SEA CADET CORPS U.S. NAVY LEAGUE CADET CORPS

RECORD OF SWIM QUALIFICATION

INSTRUCTIONS 1. The criteria listed meets U.S. Navy basic swim qualification standards. 2. Use this form to evaluate all NSCC/NLCC personnel. 3. Make an appropriate entry in the Administrative Remarks (NSCADM 008) stating assessment level and retain original in unit files or service jacket. 4. Submit a copy to the COTC when proof of Swim Qualification is required to attend Advanced Training.

1. MEMBER INFORMATION 1a. Last Name

1b. First Name

1c. MI

1d. Rate

1e. Unit Name

1f. Drill Location

1g. Location of Assessment

2. SWIM SKILL ASSESSMENT

SHALLOW WATER SWIM 15 YARDS IN CHEST DEEP WATER

DEEP WATER SWIM 15 YARDS IN WATER OVER HEAD

TREAD WATER FOR ONE MINUTE

PRONE FLOAT FOR ONE MINUTE

Yes No Yes No Yes No Yes No

If all skills are mastered continue to Section 3. If not, skip to Section 6. 3. THIRD CLASS SWIMMER ASSESMENT

DEEP WATER JUMP FROM A MINIMUM

HEIGHT OF FIVE FEET

50 YARD SWIM DEMONSTRATE THE FOLLOWING PRONE FLOAT

FIVE MINUTES

WATER SURVIVALSHIRT AND TROUSER INFLATION FRONT CRAWL BREAST STROKE BACK STROKE ELEMENTARY

BACK STROKE

Yes No Yes No Yes No Yes No Yes No Yes No Yes No

If all skills are mastered continue to Section 4. If not, skip to Section 6. 4. SECOND CLASS SWIMMER ASSESMENT

100 YARD SWIM DEMONSTRATE THE FOLLOWING PRONE FLOAT

FIVE MINUTES BACK FLOAT

FIVE MINUTES FRONT CRAWL 25 YARDS

BREAST STROKE 25 YARDS

BACK STROKE 25 YARDS

ELEMENTARY BACK STROKE25 YARDS

Yes No Yes No Yes No Yes No Yes No Yes No

If all skills are mastered continue to Section 5. If not, skip to Section 6. 5. FIRST CLASS SWIMMER ASSESMENT

100 YARD SWIM DEMONSTRATE THE FOLLOWING USING STRICTER CRITERIA THAN SECTION 4 PRONE

FLOAT FIVE

MINUTES

BACK FLOAT FIVE

MINUTES

25 YARD UNDERWATER SWIM

DEMONSTRATE BURNING OIL MANEUVER (TWICE) FRONT CRAWL

25 YARDS BREAST STROKE

25 YARDS BACK STROKE

25 YARDS ELEMENTARY BACK STROKE

25 YARDS

Yes No Yes No Yes No Yes No Yes No Yes No Yes No

If all skills are mastered continue to Section 6. If not, skip to Section 6.

6. CERTIFICATION

“The above listed individual has been assessed and is certified at the following swim qualification level”

Basic Swimmer Third Class Swimmer Second Class Swimmer First Class Swimmer

6a. Full Name and Rank of Certifying Individual (Print of Type)

6b. Signature of Certifying Individual

6c. Date (DD MMM YY)

NSCTNG 015 (REV 01/12)